GROUND ZERO

MOBILE PHONE TECHNOLOGY FOR RAPID

HOUSEHOLD LEVEL DIARRHEA REPORTING FOR COMMUNITY
DIRECTED
INTERVENTION INITIATIVES.
THE INNOVATION

• The innovation named “COHESION”; implements a Smart phone App platform

incorporating Biometrics identification to gather realtime daily diarrhea information at
household level & relays it to community health workers for intervention.
• “Cohesion©”, is COHESU’s homegrown Smartphone App.
• Simple Smartphone’s & portable biometric scanners (Simprints™) will collect and
collate household level daily Diarrhea information.
• The system works using the Kenya Essential Package of Health (KEPH), with a
particular interest in Pregnant women / infants & children under 5.
 GROUND ZERO EVOLUTION
• In 2013 we developed an exploratory system to assess:
• ACCESSING HOUSEHOLD LEVEL HEALTH INFORMATION THROUGH MOBILE PHONE TECHNOLOGY IN USOMA,
WESTERN KENYA.

• Objective: To determine the usefulness of mobile phone rapid Short Message Service (SMS) in obtaining age related
household level information on diarrhea cases.
• Design: The 11 weeks study was a combination of an experimental and descriptiveapproach that involved the mobile
phone as an intervention
• Setting: Usoma Village is located within 2 kilometers of Lake Victoria, in Western Kenya.
• Subjects: There were 971 participants from 100 randomly selected compounds, grouped according to the six distinct life
cycle stages recognized by the Kenya Essential Package of Health.
• System was “SMS based”
 SUMMARY EVOLUTION / ADAPTATION
• GROUND ZERO • GROUND ZERO 1.0
Discovery / Proof of concept : (SMS Based)
Technological Disease Surveillance ( Surveillance Proof of concept)
Approach is:
- Rudimentary technology utilising SMS (Short Message Services)
- Targeted
- Parallel Reporting: Home SMS to Server / CHV manual Recording at
home visit
- Home based Daily SMS Loose Stool Monitoring and Reporting
- Hard Copy Guided
- Weekly printed Report to CHV for Diarrhea Flagging and Visit
scheduling
- Data Reported to CHV reporting forms / Records
- Periodic updates to DHIS for data comparison
Our surveillance enabling data gaps by:
- Visualizing Occuring diarrhea in participating homes
- Household Based Enumerator
- Curate the relevant data Securely - Daily Diarrhea Occurence Per Home
- Report / analyse / insight - for potential of homes in personal health
reporting with loose stool algorithm to identfy diarrhea ; as a use case
Associated Tech:
SMS based (Collect and Report) / Frontline (SMS) / Native Database
Security ( Receiving Server / Aggregator)
FrontlineSMS / Ken Banks / Kiwanja Foundation
Simprints advisory board member.
• Ground Zero 2.0
Implementation : (Platform based / Integrations)
Piloted : (Smartphone / App Based)
Community Health & Social Services Platform (Platform as a
Community Health Services Surveillance ( Surveillance as a Service)
Approach is: Service)
- Targeted Approach is:
- Smart Phone App Guided /User Training - Holistic
- Home based Daily Loose Stool Monitoring and Reporting
- Home based service provision
- -Via a CHV - Diarrhea Flagging and Visit scheduling
- Co-Morbidity Tracing: Malaria / Fever / Symptom Noting
- All Features of Ground Zero 1.0
- Integrated Anthroprometrics (Weight / Height ) - App / Web Reporting Portals
- In-built Age stratification (KEPH category of Kenya Community - Via a CHV as Key Entry Point
Stratergy) - Supervised by PHO(Clinic)
- Offline Capacity
- Overseen from sub county ( As enabling partner)
- Off-site Connectivity Bundle weekly updates
- Remote Updating
- Oversight from County ( Via Sub County Reporting)
- Support Enumerator For home and chv device and App challenges
- Data Reported to PHO(Clinic) - CHV Log Book Records Our bridging platform enabling data gaps by:
- Periodic updates to sub county team
- Sub-County updates County
- Record the interactive process,
- Curate the relevant data Securely
Our bridging platform enabling data gaps by:
- Report / analyse / insight - for response services, policy
- Record the interactive User process - CHV / Household Based Enumerator guidance and Effective service implementation at grassroots
- Curate the relevant data Securely - Daily Diarrhea Occurence Per Home home level
- Report / analyse / insight - for response services, policy guidance and
Hence the Tag: "Ground Zero"
Effective service implementation at grassroots home level
Hence the Tag: "Ground Zero"
Associated Tech:
Associated Tech: Android / Bio-metrics / Block-Chain / A.I (Open CV)
Android / Bio-metrics / Secure Cloud Backup (Realm Implementation)
 ABBREVIATIONS & KEY WORDS
• PHO – Public Health Officer
• CHV /CHW – Community Health Volunteer / Community Health Worker
• COHESION – Android Based App Designed By COHESU
• ORS – Oral Rehydration Salts
• RDT – Rapid Diagnostics Test
• Vero Scanner – Portable Hand-Held Biometric Fingerprint scanner
• Simprints™ - UK Based Non-Profit collaborator designing the Vero Biometric Scanner
• BOMA – Swahili for House-Hold and a house hold is made up of several homes depending on the
number of marital homes , sons homes and rentals a homestead is made up of (Any where from 1-9
homes, give or take)
• Diarrhea – WHO standard for its definition is that 3 or more loose stool events within 24Hrs
constitutes a diarrhea bout / COHESION Calculates using this as part of its Back end algorithm
 KEY CONCEPTS / TAKEAWAYS
• COHESION is an android based smartphone mobile application
• We use one of a kind Simprints Biometrics scanner called Vero scanners
• The COHESION application sits in every enrolled household / homestead (Boma) for the
targeted 100 bomas / homesteads. That accounts for 100 smartphones placed in each of this
homes.
• 1 Household (Boma) could easily have 1-8 houses in total covered per phone
• Everyday a “Boma” will declare whether or not each resident both young and old has had any
loose stool occurring / or not. The essence being every Boma must interact with the health app.
• COHESION currently also collects Malaria for this particular trial. This is possible with
Community Workers who are trained and enabled to test.
• A possible critical in-design proponent of the platform is our work on “Blockchaining” our
data process for solid transparency, verification and tamper-proofing data and reporting
integrity. An up-hill task but critical to scaling and Government Integration.
 COHESIO APP / TOOLS SCREEN SHOTS
Time stamped Loose Stool daily Logs
That trigger diarrhea recordings

House Hold Members Listing

Landing Page
Red Geo-Tag Bubble = Diarrhea
Affected home Beneficiary / Patient Name
Green Geo-Tag Bubble = Diarrhea Free details and Biometrics
Home
Real-time Reported
 EXPERIENCE
GALLERY

KISIAN CHV
(Joan)

KISIAN CHV
USOMA CHV (Ben)
(Sam) With Innovator / P.I Nick Sabwa (Left)
With COHESU Field Technician Tobias
Tolo (Right)
COMMUNITY UPTAKE & CHALLENGES
Rota Community giving their blessing
and consent for a New CHV; Milestones
Getting communities to accept new
approaches to tackling their health matters
is never easy.
Whether it be, Technology, Social workers
or Concepts that are alien.
Working through the kinks and fears is very
critical.
Consensus is usually, if not amazingly, met
by guiding the communities in a transparent
methodology through the processes of
innovations that we as COHESU hope to
empower them with.
Critical to this, is then allowing them to
assimilate it in the way they see best. For
the ground zero approach, getting
communities to accept and flawlessly work
with CHV’s has been a challenge of sorts
and an amazing learning process
 DESCRIPTIVE OVERVIEW OF TH COHESION PLATFORM

• From an innovation stand point, we have digitized the process of homes reporting
real-time health events at the house-hold level and using the power of the
cloud/internet and Mobile App Building.
• Households are able to post occurring health events to their respective CHV's - who
then respond accordingly as mediators of the local health facility. This allows rapid
response and interventions for various health indicators.  
• For the Pilot phase we are Monitoring / Focusing on Diarrhea with a critical emphasis
on Children , Infants and Expectant Mothers and its impact on Maternal Health Care
• We are leveraging the system further with codependent indicators that are hard to
ignore as we move along such as Fevers & Malaria Amongst others as part of our
attempt at scaling as its highly possible they relate to diarrhea events.
 TIERED APPROACH
• Our platform uses a  4 tiered system, with each tier tethered to each and every other tier in order to provide cross data sharing, insight and
transparency. The Key 4 system aspects of the platform are:
•
1. COHESION :
•  An in-house android based mobile App we designed from the ground up to cater for on-site data acquisition, mapping, reporting and
verification.
• 2. Simprints Biometrics Scanners System: 
• A biometrics verification system integrated into our COHESION app allows pinpoint beneficiary enrollment, identification/verification. This
allows accurate records allocation and recall that's seamless, rapid and available on-demand for both administrative and enumerator / CHV use.
Simprints (UK) are great working partners and collaborators.
• 3. CHV Dependency (Future PHO / Clinic Interface): 
• After numerous trials and revisions, we have established "Registered CHV's" attached to their respective entry-level health facility (Level 1)"
as the most viable human resource-based intervention tool for our system - in terms of reaching out to homes. CHVs are critical in the tiered
system. We ensure this through appropriate training, capacity building and participatory feedback - that influences the needs and design of the
system. They are our primary enumerators / users of the system and its applications - and as such, guide our design principles in a big way.
• 4. Cloud Integration Interface: 
• A big fancy word for Secure, de-identified, encrypted, globally available data storage of the shared data/information using our very own
proprietary data layout for mission-critical custom mapping and analytics.
 WHERE DO WE GO FROM HERE?
• Power Dashboard For taking us to the next level of reporting real-time not Just for Ground Zero But as a pilot for all our programs in
COHESU being able to report online. This would guide every program such as Mavuno, Seam and Tunga on where they are and
where they are headed in terms of Visual Coverage on maps / Where our beneficiaries are and importantly ability to biometrically
• Strive to bring in Government participation and investment seeing that we have sub-county level Interest at hand. Its important the
Government becomes our Greatest champion at Grass-roots level.
• Possible funding to allow us try the system on the larger, possibly the whole population block encompassing the three village areas
we are focusing on.
• Summary analytics presentation of our data (Visually and with Metrics) from the massive dataset we are currently generating is a
priority and in the making with a critical “Live-View”. This is upcoming and in testing and sharing in the immediate days to follow.
• There is a much more under the hood but this is the guiding work-through of how we have designed our platforms various systems
and routines. There have been quite a number of changes / iterations over time as the whole idea sits and sets itself into a groove that
we deem reliable and effective. So far it has been breathtaking and an eye-opener to the opportunities CHV's present in making
Health impacts within communities

• “Great things are not done by impulse, but by a series of small things brought together.”
George Eliot
THANK YOU / SHUKRAN

COHESU ®

2019